| NPI | 1952942500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESSA FUENTES Billing Manager 323-268-9191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2020-10-23 |